Q&A: Is It Worth Seeking an ADHD Diagnosis After 50?
ADHD doesn’t disappear with age. Yet many older adults with symptoms of ADHD are misdiagnosed and go without proper treatment and care. In this expert Q&A, learn why a thorough evaluation is critical and what lifestyle changes may help most.
Older adults are suffering needlessly due to undiagnosed ADHD. This is unfortunate — and unfortunately common because many health professionals are not trained to consider ADHD in patients older than 50, even when they demonstrate a clear pattern of behavioral patterns and symptoms.
This lack of awareness and training extends beyond diagnosis and into effective treatments for this demographic. Learn more about the importance of screening for attention deficit hyperactivity disorder (ADHD or ADD) in older adults, along with proven treatment and lifestyle intervention, in this Q&A session with Kathleen Nadeau, Ph.D., director of the Chesapeake ADHD Center in Bethesda, Maryland.
Q: What is the best way to find a doctor who specializes in ADHD in older adults?
It’s not easy. Major metropolitan areas tend to be home to strong ADHD specialty clinics. If you’re located outside a city, it’s a good idea to get a formal assessment in such a place to bring back to your primary care physician for ongoing care, especially if they don’t feel qualified to evaluate you, or are reluctant to do so. These forms outline the diagnostic procedure and the recommended treatment course for the individual.
It’s also important to note that anyone who is truly an expert in diagnosing ADHD in older adults will not limit themselves to the DSM-V for diagnosis because the ADHD symptoms listed therein apply largely to children and do not reflect the adult experience with attention deficit for most people.
As a patient, I’d question clinicians who rely too much on understanding your ADHD symptoms in childhood. If others, like siblings, can speak to this, then it is helpful information. But, for the most part, interviews about the distant past will likely yield inaccurate responses. Whose memory is accurate 60 years later? Beyond that, symptom presentation can differ over the years, and lifestyle factors can do a great deal in “concealing” ADHD symptoms.
Q: Speaking of symptoms – for women, can diagnosis be complicated later in life by menopause?
What we know is that the brain is a target organ for estrogen. What that means is that, when estrogen levels fluctuate, our dopamine and serotonin receptors — which are linked to attention, self-management, anxiety, and mood disorder — are less sensitive. We also know that estrogen levels start declining on average at around 40, and that decline over many years can greatly exacerbate ADHD symptoms. Overall, there is ample evidence to suggest an estrogen-ADHD symptom connection, and we need more research on the link.
Q: What treatments and interventions are best for older adults with ADHD?
One of the first things I talk about with older patients after diagnosis is instilling brain-friendly daily habits that improve health and cognition. This includes:
- Sleep: Recent research shows that during certain phases of deep sleep, our brains are cleansed of the toxins that can become the beginning of Alzheimer’s, for example. Adequate sleep is critical to overall health and functioning.
- Nutrition: I always counsel patients to consume low-glycemic foods, to limit starch and sugar, and to have protein at every meal. This combination makes for a level supply of glucose, which is what our brains run on.
- Stress management
Structure and social interaction are crucial for older adults with ADHD as well. It’s important to remain connected to others, as healthy relationships boost our mood and focus. I encourage my patients to take active steps toward social interaction in activities and meeting others. One way to do so is through senior living communities, where social life and activities are built in. Some older adults may also benefit from working in retirement.
Executive function coaching is also a great way to promote structure by working on everyday issues with problem-solving, habit development, time management, organization, money management, and so on.
Q: What about stimulants? Are they safe to prescribe to older adults to treat ADHD?
In my experience, a great many adults can tolerate stimulant medication and benefit from them. For individuals with cardiovascular problems, approval from a primary care physician or cardiologist is needed prior to prescribing stimulants (this goes for a patient with ADHD of any age). We also start prescribing at very low doses.
Overall, many psychiatrists and primary care providers are reluctant to prescribe stimulants, and often for no good reason. They’re usually worried about the interaction between stimulants and other medications, as older adults are more likely to be taking several medications, or about the impact of stimulants on the heart. I find this ironic because in geriatric medicine it’s not uncommon at all to prescribe stimulants to wake up the brain and provide energy.
Often, guidance and documentation from an outside ADHD clinic (as mentioned above) is enough to get the primary care provider to prescribe stimulants. If stimulants don’t work, older adults may also benefit from non-stimulants.
Q: Is there a significant benefit to a late-life ADHD diagnosis?
There are tremendous benefits to getting a diagnosis at any point in life, but certainly this is true in later years. I do hear people make ageist statements sometimes, like, “Why does it matter if you have ADHD? You’re 72.” But it does matter; having a diagnosis and proper treatment hugely impacts quality of life.
Living with undiagnosed ADHD makes life more stressful, and makes individuals feel badly about themselves. The diagnosis alone is therapeutic, and it allows us to help older adults restructure their lives. My advice to older adults who think they have ADHD is to stop dismissing yourself.
The content for this article was derived from the ADDitude Expert Webinar “ADHD in Older Adults: From Late Diagnosis to Treatment Strategies” by Kathleen Nadeau, Ph.D., (podcast episode #331), which was broadcast live on November 5, 2020.
Older Adults with ADHD: Next Steps
- Read: Inside the Aging ADHD Brain
- Guide: How to Retire with ADHD – Structure, Stimulation, Purpose
- Resource: When I’m 64 – Why ADHD Treatment Gets Tougher with Age
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